PREDICTORS OF COMPLICATIONS AFTER
ANTERIOR CRUCIATE LIGAMENT INJURY
Daniel Andernord
AKADEMISK AVHANDLING
FAKULTETSOPPONENT
som för avläggande av medicine doktorsexamen vid
Sahlgrenska akademin, Göteborgs universitet, kommer
att offentligen försvaras i sal Arvid Carlsson,
Medicinaregatan 3, torsdag den 30 april 2015 kl. 09:00
Professor Lars Engebretsen
Institutt for klinisk medisin
Det medisinske fakultet
Universitetet i Oslo, Norge
AVHANDLINGEN BASERAS PÅ FÖLJANDE DELARBETEN
I.
Andersson D, Samuelsson K, Karlsson J
Treatment of anterior cruciate ligament injuries with special reference to surgical
technique and rehabilitation: an assessment of randomized controlled trials
Arthroscopy. 2009;25(6):653-685
II.
Samuelsson K, Andersson D, Karlsson J
Treatment of anterior cruciate ligament injuries with special reference to graft type
and surgical technique: an assessment of randomized controlled trials
Arthroscopy. 2009;25(10):1139-1174
III.Andernord D, Karlsson J, Musahl V, Bhandari M, Fu FH, Samuelsson K
Timing of surgery of the anterior cruciate ligament
Arthroscopy. 2013;29(11):1863-1871
IV. Andernord D, Björnsson H, Petzold M, Eriksson BI, Forssblad M, Karlsson J, Samuelsson K
Surgical predictors of early revision surgery after anterior cruciate ligament recon struction: results from the Swedish national knee ligament register on 13,102 patients
The American Journal of Sports Medicine. 2014;42(7):1574-1582
V.
Andernord D, Desai N, Björnsson H, Ylander M, Karlsson J, Samuelsson K
Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up
The American Journal of Sports Medicine. 2015;43(1):121-127
VI. Andernord D, Desai N, Björnsson H, Gillén S, Karlsson J, Samuelsson K
Predictors of contralateral anterior cruciate ligament reconstruction: a cohort study
of 9061 patients with 5-year follow-up
The American Journal of Sports Medicine. 2015;43(2):295-302
Göteborg 2015
PREDICTORS OF
COMPLICATIONS AFTER
ANTERIOR CRUCIATE
LIGAMENT INJURY
DANIEL ANDERNORD
Department of Orthopaedics
Institute of Clinical Sciences
Sahlgrenska Academy at
University of Gothenburg
Gothenburg, Sweden
ABSTRACT
BACKGROUND: An anterior cruciate ligament (ACL) tear is a serious knee injury that
frequently affects young individuals active in soccer, alpine skiing, handball and basketball.
Regardless of treatment, an ACL injury is associated with an increased risk of complications in
the short and long term, such as meniscal and chondral injuries or a need to undergo surgery on
the injured knee or the contralateral knee. In order to prevent these complications, the essential
first step is to obtain knowledge of factors that make certain individuals susceptible to certain
complications.
AIM: The aim of this thesis was to investigate patient- and health care-related factors and
identify predictors of meniscal injury, chondral injury, revision surgery and contralateral ACL
reconstruction.
METHODS: This thesis is based on six studies. Studies I-III are systematic reviews of randomized controlled trials and cohort studies. Studies IV-VI are registry-based cohort studies of
patients in the Swedish National Knee Ligament Register.
RESULTS: Individuals with an ACL injury who underwent non-surgical treatment ran a more
than 10 times higher risk of sustaining meniscal injuries and an at least 4 times higher risk of
requiring meniscal surgery compared with individuals who underwent ACL reconstruction.
Adolescents (individuals aged 13 to 19 years) who underwent ACL reconstruction ran a 2 to
3 times higher risk of revision surgery or contralateral ACL reconstruction. Adolescents who
suffered an ACL injury while playing soccer ran a 3 times higher risk of revision surgery. Females
who underwent ACL reconstruction with harvest of a contralateral hamstring tendon autograft
ran a more than 3 times higher risk of future contralateral ACL reconstruction.
CONCLUSIONS: Non-surgical treatment, age 13 to 19 years, injury during soccer and contralateral hamstring tendon harvest were predictors of serious complications after ACL injury.
KEYWORDS: Sports medicine, evidence-based medicine, knee, joint, menisci, cartilage, osteoarthritis,
arthroscopy, physical therapy, rehabilitation, sex, adolescent, teenager, football
ISBN: 978-91-628-9296-8 (print)
ISBN: 978-91-628-9297-5 (e-pub)
Göteborg 2015